Tacocina
-
~ _~~JW~[fd) s ORIGINAL APPLICATION NOTICE FORM for Providing a
-.., . STATE FNE an- Notice 10 a Local Mnnicinalitv or Community Board
, . . .~~ ~, EXECUTf E DEPARTMENT
DIVISION OF ALCOI [)L1CBEVERA~r~ 2010 ilf comoectiolf with the submission to the Stale Liquor Authority of the
.... .. ~___}. -'. fI , .. -irst\ On-Pr..mises Alcoholic Beve......e Lic..nv Annliuoon
STATE Lie:; UOR AUTBO for the Establish_at Identified in this Notice (paae 1 of 2)
-- . --
~oJcX~~ ~~~'Tf ~e ~,a ~UI .. -I 7 1 :i:~ .., .., 2 1 0 1 ':i I ~I
I. Date the Original copy of this nif '5: '!l or Coma unity Board: / C
TInS LED TO THE CLERK OF THE
FOIl.OWlNG LOCAL MUNICIPAUTY OR COMMl)NITY BOARD
2. Name of the Local Municipality or Community Board: "Ie ...I I? p.f" W~--" _/l~"",~ F'~ 11!5
3. Street Address of Local Municipality or Community Board: 7~ HI, J" l~ J?u.,~' ~cI
4. City, Town, or Village: I W6.A _ ~M A tt- i" S F~II ~ NY 1 Zip Code: J'z. 5'? 0
. OJ 1t"ILtISI- 12 1917 1 Z171~111
5. Telephone Number of Clerk of Local Municipality or Community Board: -
ATI'ORNEY REPRESENTING THI!: APPLICANT IN CONNECTION WITH THE APPUCANT'S
ORIGINAL (FIRST) ON-PREMISES ALCOHOUC BEVERAGE UCENSE APPLICATION FOR THE ESTABUSHMENT IDENTIFIED IN TIDS NOTICE
6. Attorney's Full Name is: l'llf t' O.$.$ D C/O Tt:.$ 'ffe- .)0;''' C; 1/1~'5 A lie
v I" .., .4G"" ,
7. Attorney's Street Address: 2.s1 L.."
PL)~/.", ~ - Zip Codej '2.5" .y
8. City, Town, or Village: NY .Ny
-J 1i>1'f 1.;1 1 ~ 15 1 ~ 1.:5 I~ II I~ 1
9. Business Telephone Number of Attorney: - -
THE APPLICANT WILL FILE AN ORIGINAL (FIRSr) APPUCATION FOR AN ON-PREMISES ALCOHOUC BEVERAGE UCENSE
IN ORDER TO CONDUCT - WITHIN THE IDENTlFlED ESTABUSHMENT - THE TYPE OF BUSINESS DESCRIBED BELOW
10. Type(s) of Alcohol to be sold under the License ( "X"!ID!<l: 0= o Wine and Beer Only ~ Liquor, Wine, and Beer
Extent of D Restaurant (Sale of Food D Tavern-Restaurant (A mixed-use establishment that D Tavern / Cocktail Lounge / Adult Venue /
II. Food Service: Primarily; Full Food Menu; has both a sit-down dining area and a 'stand-up' bar Bar (Alcohol sales primarily - meets legal
( 'X. !ID!<l Kitchen run by Chel) where patrons may receive direct deliveries of alcohol) minimum food availability requirements)
12. Type of o Hotel OLive D Disk D Juke o Patron Dancing D Cabaret, Night Club, Discotheque D Capacity for 600
Establishment: Music Jockey Box (Small Scale) (Large Scale Dance Club) or more patrons
t::P D Club (e.g. Golf / D Bed & D Catering D Stage D Topless ~ Other
( "X" all ...
that apply) ~ Fraternal Org.) Breakfast Facility Shows Entertainment (Specify): R.".... te,U .J,"/~A -t
13. Proposed ~ None D Rooftop o Patio D Freestanding D Garden / D Other
Outdoor Area(s): or Deck Covered Structure Grounds (Specify):
14. Will the proposed License Holder or a Manager be physically present within the establishment during All Hours of Operation? ('X"!ID!<l: I ~ YES I D NO
15. Application Serial Number: Pe M d I i-I 61
16. The ADDlicant's Full Name. as it will appear in the application 7/''''_10'' _A ~ot!-41:~-.. 1 rl 7F /_,.
for the On-Premises Alcoholic Beverage License, is:
17. The Full Name of the Applicant's proposed licensed Establishment (the Trade Name Ln.. "7"" ,6J ~ ...., ~ _.& ' ,j
under which the proposed Licensed Establishment will conduct business) is:
18. The Applicant's proposed Licensed Establishment is located /2.8 f Cdl"'btP....4 -Ie ~/IC- ;Z~, 9 .5p,ee I
within the building which has the following Street Address:
19. City, Town, or Village: I W.t,j, 10 ~rll ~I'" ~ ru//$ INY Zip Code/ Z .5 9 t?
20. The proposed Licensed Establish:rent will be located on the following floor(sl of the building at the above address: 1 a"'HA. d
2I. Within the building at the above address, the proposed Licensed Establishment will be located within the room(sl numbered as follows: 1 I
22. Business Telephone Number of the Applicant ~ 4/ !f - C. $ '2.. - .~ 9 'I ~
23. Business Fax Number of the Applicant - -
24. Business E-Mail Address of the Applicant
IF YOU KNOW - Was there ever an alcoholic beverage license in effect for the space where I I I
25. you intend to operate your licensed establishment? Yes D No ~ I Don't Know D
OWNER OF THE BUILDING IN WHICH THE PROPOSED UCENSED ESTABUSHMENT WILL BE WCATED
Does the Applicant own the building in If''YES'', SKIf items No. 27, 28, 29, & 30 If'NO", ~ items No. 27, 28, 29, & 30.
26. which the proposed Licensed Yes D Go directly to Item No. 31, No~ Then continue to Item No. 31,
Establishment will be located? ( 'X" ~ and complete the form. and complete the form.
27. Building Owner's Full Name is: if .." Ii Y1 L ~"n' d
28. Building Owner's Street Address: /?_Q q .ebt.l-t'~ Q
29. City, Town, or Village: I w...... _ ,,.,. ... ...".:S /,,11.> 1';'1 Zip Code: 12-5 9 e7
"" ~ g 6' to ~ 2- 01
30. Business Telephone Number of Building Owner: I.j - 9 g- - ~
12-11-2008,p.1 (02)
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Sf ATE OF NEW YORK
EXECUTIVE DEPARTMENT
DIVISION OF ALCOHOLIC BEVERAGE CONTROL
STATE LIQUOR AUTHORITY
Slandardized ORIGINAL APPLICATION NOTICE FORM for Providing a
3O-Dav Advance Notice 10 a Local Munidoalitv or Community Board
in ronnection with the submission to the State Liquor Authority a/the
ADoIiunt's Oritrinal (FirsO On-Premises Alcoholic Beveral!e License ADDlication
for the Establishment Identified in this Notice (Paae 2 of 21
IN ORDER TO MAKE SURE THAT PAOES I AND 2 OF YOUR NOTICE ARE NOT SEPARATED OR MISPLACED,
PLEASE RE-ENTER IMMEDIATELY BELOW THE INFORMATiON REGARDINO YOUR APPLICATiON SERiAL NUMBER, NAME, AND TRADE NAME.
YOUR COURTESIES ARE APPRECIATED
15. Application Serial Number: T Pc,. J /,:, it
16. The Aoolicant's Full Name. as it will appear in the applica"'fion I 7", 4()1 ,.., J_ ~ it? e,~-tb " I" A,.. -t
for the On-Premises Alcoholic Beverage License, is: I"a.
17. The Full Name of the Applicant's proposed licensed Establishment (the Trade Name t~s ~~. .~"",'5
under which the proposed Licensed Establishment will conduct business) is:
UIFOJUlATlOIl RBOARDIIIO AllY 8U8111B118 LlCUBBD TO 8BLL ALCOHOLIC 8BVBR&O- THAT 18 .............y -0 OPPATBD III THB SPACB
WHERE THE APPLICANT INTENDS TO OPERATE HiS/HER/ITS PROPOSI!:D LICENSED ESTABLISHMENT
31. IF YOU KNOW - Is a business that is licensed to sell alcoholic beverages currently being conducted Yes 0 No J(l I Don't Know 0
in the space where you intend to opemte your licensed establishment?
Are you buying any asset(s) owned by the opemtor of the licensed business currently being conducted
32. in the space where you intend to opemte your licensed establishment? Yes 0 No IKI
(For example: good will, equipment, furniture, cookware, dishware, etc.)
IF YOU ANSWERED -vES. TO ITEM 31 or 32, SKU' ITEMS NO. 33 and 34. 00 DIRECTLY TO ITEMS NO. 35, 36, 37, 38, 38, and 39.
IF YOU ANSWERED ~ TO ITEMS 31 and 32, PLEASE PROVIDE THE INFORMATION REQUESTED BY ITEMS NO. 33 and 34.
IF A BUSINESS LICENSED TO SELL ALCOHOLIC BEVERAGES mJiQI CU~ENTI,.Y BEING OPERATED IN THE SPACE
WHERE THE APPLICANT INTENDS TO OPERATI!: HIS/HER/ITS PROPOSED LICENSED ESTABLISHMENT, PLEASE PROVIDE
IIIJ'OJUlATlOIl RBOARDIIIO AllY 8U8IIIBII8 LlCU8IID TO 8BLL ALCOaOUC BBVBRAOIIII 'l'IIATWU IlO8T IIBCBIITI.Y OPBRATBD III THB SPACB
33. IF YOU KNOW - Was a business that was licensed to sell alcoholic beverages previously conducted 0 No~ I Don't Know 0
in the space where you intend to opemte your licensed establishment? Yes
Are you buying any asset(s) owned by the opemtor of the licensed business that was most recently conducted
34. in the space where you intend to opemte your licensed establishment? Yes 0 No RI
(For example: good will, equipment, furniture, cookware, dishware, etc.)
IF YOU ANSWERED -vES. TO ITEM NO. 31 or 32 or 33 or 34, THEN PLEASE ANSWER ITEMS NO. 35 and 36 and 37 and 38 and 39.
IIIJ'OJUIATlO. ABOUT THE OPERATOR OF TD LlCU8IID B08111B118CORlt111lTLY BaKe COJIDOCTBD (OR .QIJT ItBCISIITLY COJIDUCTBD) IN THE SPACE
WHERE THE APPLICANT INTENDS TO OPERATI!: HIS/HERf1'l'S LICENSED I!:STABLlSHMENT. PI&A8a PROV1D8 TD J'OLLOWIIIO IIIJ'OJUlATlOIl:
IF YOU KNOW -
35.
IF YOU KNOW -
36.
IF YOU KNOW -
37.
IF YOU KNOW -
38.
The Full Name of the Opemtor of the licensed business
now being conducted (or that was most recently conducted)
in the space where you intend to opemte your licensed establishment:
The Full Name of the licensed Estahlishment (the Trade Name)
now being opemted (or that was most recently opemted)
in the space where you intend to opemte your licensed establishment:
The alcoholic beverage license serial number of the business
now being conducted (or that was most recently conducted)
in the space where you intend to opemte your licensed establishment:
I Don't Know 0
I Don't Know 0
I Don't Know 0
The Type of Alcoholic Beverage License held by
the current (or most recent) licensed opemtor:
I Don't Know 0
39.
IF YOU KNOW - Telephone Number of the current licensed opemtor
or the most recent licensed opemtor:
I Don't Know 0
If the Original Application is approved, I am the Person who will hold the Ucense or I am a Principal of the Legal Entity that will hold the Ucense.
Representations in this form are in full conformity with representations made in documents that have been submitted
40. (or documents that will be submitted) to the State Uquor Authority, and relied upon by the Authority.
I understand that representations made in this form will be also relied upon by the Authority, and that false representations in any document
submitted to the Authority may result in revocation of any license that may be issued.
By my signature, I affirm - under PeD8ltJ of hIj1uJ - that the representations made in this form are true.
Printed Name
Title
Signature
Jt> A,., (;,11,,> ,P/~
f? ~"i"I!-.:J.e" ell -t-' ~ e,
x
12-1f-2Ot'I8,p2 (02)
jfg & associates. Inc
Consultants
25 juniper lane
pawling, ny 12564
Phone: 845-855-3616
Fax: 845-855-3003
Email: jfgassoc@verizon.net
John F. Gillespie, President
Mike Leonard, Associate
December 13,2010
Town ofWappengers Falls
20 Middlebush Rd
Wappengers Falls, NY 12590
Attn Town Clerk
Enclosed please fmd 30-Day notice of Tacocina Restaurant Inc.'s intention of filing for an
on-premises liquor license under ABC laws.
As you are aware there was a notice to the Town that Thalia Rodriquez was applying for a
license due to financial considerations this application is not going forward.
If the Town Board has no objection to this application we would like to ask if they can wave
the 30-Day provision.
If I can supply any additional information please let me know
Sincerely
iff!;:
lR1~cc~n~~lQ)
DEe 1 4 2010
TOWN OF WAPPINGER
TOWN CLERK
TOWN CLERK
Chris Masterson
TOWN SUPERVISOR
Christopher J. Colsey
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS. NY 12590
WWW.TOWNOFWAPP1NGER.US
(845) 297-4158 - Main
(845) 297-5771 - Direct
(845) 298-1478 - Fax
TOWN BOARD
William H. Beale
Vincent Bettina
Ismay Czarniecki
Joseph P. Pao\oni
Office of the Town Clerk
December 14, 2010
New York State Liquor Authority
80 South Swan Street
Suite 900
Albany, New York 12210
Attn: Renewals
Dear Sirs:
Please be advised that the Town Board ofthe Town of Wappinger has been notified by
Tacocina Restaurant rnc, located at 1289 Corporate Park, Wappingers Falls, New York,
of intention to file an application with the New York State Liquor Authority.
As this location is within the Town of Wappinger, the Town Board has received and
directed that this application be placed on file with no comment.
Sincerely,
JCM/cf